Session number: 1001
Abstract title: Potential Cost Savings for Erythropoietin for ESRD: Translating Results from a VA RCT to Medicare
Author(s):
DM Hynes - 1VA CSPCC, MCHSPR, VIReC, Hines VA Hospital, Hines, IL
Loyola University Chicago, Maywood, IL
KT Stroupe - VA CSPCC, MCHSPR, VIReC, Hines, IL
Northwestern University, Evanston, IL
DJ Reda - VA CSPCC and VIReC, Hines, IL
JW Greer - Centers for Medicare and Medicaid Services, Office of Strategic Planning, Baltimore, MD
DL Frankenfield - Centers for Medicare and Medicaid Services, Office of Clinical Standards and Quality, Baltimore, MD
JS Kaufman - Renal Section, VA Boston Healthcare System, Boston, MA
WG Henderson - Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Hines VA Hospital, Hines, IL
J Kang - Centers for Medicare and Medicaid Services, Office of Clinical Standards and Quality, Baltimore, MD
JR Feussner - Department of Veterans Affairs, Washington, DC
Objectives: Recombinant human erythropoietin (epoetin) has substantially improved care of patients with renal failure. A Department of Veterans Affairs Cooperative Studies Program randomized controlled trial demonstrated that the epoetin dose required to maintain target hematocrit of 30%-33% was one-third less when the hormone was administered subcutaneously compared to intravenously. Since epoetin is expensive, optimizing the therapeutic impact of epoetin using a strategy that includes subcutaneous administration could result in substantial cost savings.
Methods: Using an economic cost projection model we estimated potential savings to the Medicare End Stage Renal Disease (ESRD) Program that could occur during a transition from intravenous to subcutaneous administration of epoetin among hemodialysis patients. Data included clinical results from the VA randomized controlled trial, the 1998 Centers for Medicare and Medicaid Services ESRD Core Indicators Survey, and 1997-1998 Medicare claims files. In sensitivity analyses we varied expected dose reductions (10%-50%) and proportion of patients (25%-75%) making the transition from intravenous to subcutaneous.
Results: Medicare cost savings were estimated at $47-$142 million annually as 25% to 75% of hemodialysis patients currently receiving epoetin intravenously made the transition to subcutaneous and simultaneously reduced the dose by 32%. Even assuming a minimal epoetin dose reduction (10%), Medicare cost savings were estimated at $15-$44 million annually in just the use of this one medication.
Conclusions: Administering epoetin subcutaneously rather than intravenously would provide substantial cost savings to Medicare. For the transition to occur, consensus among stakeholders is needed, especially patients whose treatment satisfaction and health-related quality of life are most affected.
Impact statement: In this study we attempted to directly translate results from a Department of Veterans Affairs randomized controlled trial to the Medicare ESRD Program. We estimated a potential impact beyond VA in which Medicare could save $47 to $142 million annually for this one medication if results from this VA RCT were translated into practice in the Medicare ESRD program.